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Molina Medicaid Solutions - DHHR

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Bridging the Rivers ofChange Together13.0 SIGNED FORMSWest Virginia MMIS Re-ProcurementSolicitation: MED13006RFP Requirement 4.1.13 Signed Forms<strong>Molina</strong> has completed and signed all necessary forms. This section’s content is not applicable to Requestfor Proposal (RFP) MED13006’s 300-page limitation. As specified in RFP requirement 4.1, all itemsexcluded from the three-hundred (300) page limit should be placed as separate sections at the back of thetechnical proposal. Please refer to Proposal Section 14.12, Signed Forms, Addenda, and TransmittalLetters. Proposal Section 14.12 includes: MED Purchasing Affidavit MED 96 Agreement Addendum HIPAA Business Associate Addendum (BAA) Resident Vendor Preference Vendor Registration and Disclosure Statement Disclosure by Fiscal Agents: Information onOwnership and Control.13-1

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